A scoping review of cost benefit analysis in reproductive, maternal, newborn and child health: What we know and what are the gaps?

Growing evidence suggests that early life investments in health are associated with improved human capital and economic outcomes. Various recent global studies have simulated the expected economic returns from alternative packages of interventions in reproductive, maternal, newborn and child health (RMNCH). However, very little is known about the comparability of estimates of the economic returns of RMNCH interventions across studies in low and middle income countries. Our study aims to fill this gap. We performed a comprehensive scoping review of the recent literature (2000-2013) on the economic returns (i.e. benefit-cost ratios) of RMNCH-related interventions, conducted in low and middle income countries. A total of 36 studies were identified. They were read in full and information was abstracted on both the estimates of benefit-cost ratios, the methodological approach and assumptions used. The estimated economic returns fluctuated considerably across settings as the associated costs of disease patterns, social behaviours and health systems varied. Yet, greater sources of variation stemmed from differences in methodology. The observed methodological inconsistencies limit the accuracy and comparability of the estimated returns across various contexts. The reviewed studies suggest that the benefit-cost ratios are favourable in the majority of cases, providing further support to a growing body of economic literature that suggests investments early in life, such as those interventions related to RMNCH, are good investments. Beyond advocacy purposes, for the reviewed literature to be used by policymakers to inform their decisions on investments, a consistent methodological approach should be adopted.